Effects of Cefixime on Immune Functions and Inflammatory Factors in Children with Urinary Tract Infection and Targeted Nursing Strategies

Objective: This study aims to explore the effects of cefixime on immune functions and inflammatory factors in children with urinary tract infection and to investigate its nursing strategies. Methods: A total of 161 children with urinary tract infection who were diagnosed in our hospital from November 2019 to November 2021 were selected. All children were treated with cefixime and received targeted nursing strategies. The indices of immune functions and the levels of inflammatory factors were compared before and after the treatment. The satisfaction degree of children’s family members, recurrence rate and incidence of adverse reactions were measured. Results: The levels of CD3+, CD4+ and CD4+/CD8+ in children after the treatment were significantly higher but the CD8+ level was significantly lower than those before the treatment (p < 0.001). The levels of C-reactive protein, tumour necrosis factor-α and interleukin-6 after the treatment were lower than those before the treatment (p < 0.001). The average score of nursing satisfaction of children’s family members was (84.53 ± 13.65) points, with the total satisfaction degree of 90.68% (146/161). Within 6 months after the treatment, only six children had urinary tract infection again and the recurrence rate was 3.73% (6/161). During the treatment, seven children had adverse reactions to the drug, with an incidence rate of 4.35% (7/161). Conclusions: Cefixime can improve the immune function of children with urinary tract infection and reduce the levels of inflammatory factors. The implementation of targeted nursing strategies can improve clinical satisfaction and reduce the recurrence rate of the disease and thus can be helpful to establish a comprehensive and efficient clinical program for children with urinary tract infection (AU)

CD4+CD25+CD127loFOXP3+ cell in food allergy: Does it predict anaphylaxis?

Background: Food allergy (FA), hence the incidence of food anaphylaxis, is a public health problem that has increased in recent years. There are still no biomarkers for patients with FA to predict severe allergic reactions such as anaphylaxis. Objective: There is limited information on whether regulatory T (Treg) cell levels are a biomarker that predicts clinical severity in cases presenting with FA, and which patients are at a greater risk for anaphylaxis. Methods: A total of 70 children were included in the study: 25 who had IgE-mediated cow’s milk protein allergy (CMPA) and presented with non-anaphylactic symptoms (FA/A−), 16 who had IgE-mediated CMPA and presented with anaphylaxis (FA/A+) (a total of 41 FA cases), and a control group consisting of 29 children without FA. The study was conducted by performing CD4+CD25+CD127loFOXP3+ cell flow cytometric analysis during resting at least 2 weeks after the elimination diet to FA subjects. Results: When the FA group was compared with healthy control subjects, CD4+CD25+CD127loFOXP3+ cell rates were found to be significantly lower in the FA group (p < 0.001). When the FA/A− and FA/A+ groups and the control group were compared in terms of CD4+CD25+CD127loFOXP3+ cell ratios, they were significantly lower in the FA/A− and FA/A+ groups compared to the control group (p < 0.001). Conclusions: Although there was no significant difference between the FA/A+ group and the FA/A− group in terms of CD4+CD25+CD127loFOXP3+ cells, our study is important, as it is the first pediatric study we know to investigate whether CD4+CD25+CD127loFOXP3+ cells in FA predict anaphylaxis (AU)

Abnormalities in subsets of B and T cells in Mexican patients with inborn errors of propionate metabolism: observations from a single-center case series

BACKGROUND: Propionate inborn errors of metabolism (PIEM), including propionic (PA) and methylmalonic (MMA) acidemias, are inherited metabolic diseases characterized by toxic accumulation of propionic, 3-hydroxypropionic, methylcitric, and methylmalonic organic acids in biological fluids, causing recurrent acute metabolic acidosis events and encephalopathy, which can lead to fatal outcomes if managed inadequately. PIEM patients can develop hemato­logical abnormalities and immunodeficiency, either as part of the initial clinical presentation or as chronic complications. The origin and characteristics of these abnormalities have been studied poorly. Thus, the aim of the present work was to evaluate and describe lymphoid, myeloid, and erythroid cell population profiles in a group of clinically stable PIEM patients. METHODS: This was a retrospective study of 11 nonrelated Mexican PIEM patients. Clinical, bio­chemical, nutritional, hematological, and lymphocyte subsets were analyzed. RESULTS: Despite being considered clinically stable, 91% of patients had hematological or immu­nological abnormalities. The absolute lymphocyte subset counts were low in all patients but one, with CD4+ T-cell lymphopenia, being the most common one. Furthermore, of the 11 stud­ied subjects, nine presented with a low CD4/CD8 ratio. Among the observed hematological alterations, bicytopenia was the most common (82%) one, followed by anemia (27%). CONCLUSION: Our results contribute to the landscape of immunological abnormalities observed previously in PIEM patients; these abnormalities can become a life-threatening chronic com­plications because of the increased risk of opportunistic diseases. These findings allow us to propose the inclusion of monitoring immune biomarkers, such as subsets of lymphocytes in the follow up of PIEM patients

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Eficacia y seguridad en condiciones clínicas reales del raltegravir en un hospital de referencia del seguro social peruano / Efficacy and safety in real clinical conditions of Raltegravir in a reference hospital of peruvian social security

INTRODUCCIÓN: El Rategravir pertenece a los inhibidores de integrasas, quedando demostrado y aprobado por diversos ensayos clínicos como un potente antirretroviral seguro y eficaz para el tratamiento de pacientes infectados con el virus de inmunodeficiencia humana (VIH), con buena tolerancia y baja toxicidad, incluyéndose en el esquema de tercera línea o rescate y se inicia cuando los esquemas de primera y segunda línea han fracasado. OBJETIVO: Evaluar la eficacia y seguridad en condiciones clínicas reales del uso de Raltegravir dentro de los esquemas de la Terapia Antiretroviral de Gran Actividad (TARGA) en pacientes con infección por VIH en un hospital de referencia del seguro social en Perú. MÉTODOS: Se realizó un estudio observacional retrospectivo en pacientes con diagnóstico de infección por VIH que iniciaron tratamiento dentro del esquema TARGA basados en Raltegravir con seguimiento y control a los 6 meses. Se presentaron medidas de resumen de frecuencias y porcentajes para las variables cualitativas, así como medias y desviación estándar para las variables cuantitativas en base a los resultados de las pruebas de normalidad. Los datos fueron procesados y analizados en el software estadístico SPSS versión 22. RESULTADOS: El género masculino fue el más afectado con un 76%(n=119) del total. El rango de edad más frecuente fue el comprendido entre los 45 a 55 años (25,4%; n=40). Las comorbilidades más frecuentes fueron Diabetes mellitus e Hipertensión arterial, con reducción exponencial de la carga viral y elevación de los niveles de linfocitos CD4. CONCLUSIÓN: El Raltegravir es eficaz para el tratamiento de pacientes VIH

INTRODUCTION: Rategravir belongs to integrase inhibitors, being demonstrated and approved by several clinical trials as a powerful and safe antiretroviral drug for the treatment of patients infected with human immunodeficiency virus (HIV), with good tolerance and low toxicity, including in the third line or rescue scheme and it starts when the first and second lineas schemes have failed. OBJECTIVE: To evaluate the efficacy and safety in real clinical conditions of the use of Raltegravir within the HAART schemes in patients with HIV infection in a reference hospital of social insurance in Peru. METHODS: A retrospective observational study was performed in patients with a diagnosis of HIV infection who started treatment within the TARGA scheme based on Raltegravir with follow-up and control at 6 months. We presented summary measures of frequencies and percentages for the qualitative variables, as well as means and standard deviation for the quantitative variables based on the results of the normality tests. The data was processed and analyzed in the statistical software SPSS version 22. RESULTS: The male gender was the most affected with 76% (n = 119) of the total. The most frequent age range was between 45 to 55 years (25.4%, n = 40). The most frequent comorbidities were Diabetes mellitus and arterial hypertension, with exponential reduction in viral load and elevation of CD4 lymphocyte levels. CONCLUSION: Raltegravir is effective for the treatment of HIV patients

Factors associated with poor linkage to HIV care and related barriers among men who have sex with men / Factores asociados a una deficiente vinculación al cuidado sanitario de la infección por el VIH y barreras relacionadas en hombres que tienen sexo con hombres

INTRODUCTION: We assessed poor linkage to HIV care in a sample of HIV positive men who have sex with men (MSM) diagnosed in Spain. METHODS: From 2012 to 2013 we recruited a sample of MSM mainly through gay-dating websites. Poor linkage to care was defined as receiving the first CD4 count > 3 months after HIV diagnosis. We performed a logistic regression analysis to estimate factors associated with poor linkage to care and analyzed the underlying reasons. RESULTS: Some 9.4% self-reported poor linkage to care. Those diagnosed in clinical settings other than sexual health clinics or in non-clinical settings presented increased odds of poor linkage to care. The most common reason was being assigned an appointment for first CD4 count > 3 months after initial HIV diagnosis. CONCLUSION: Poor linkage to care was very low, but for further improvements fast-track referral pathways should be created, especially in contexts outside sexual health clinics

INTRODUCCIÓN: Analizamos la incorrecta vinculación al seguimiento médico de la infección por VIH en una muestra de hombres que tienen sexo con hombres (HSH) diagnosticados en España. MÉTODOS: Durante 2012 y 2013 se reclutó una muestra de HSH principalmente en páginas de contactos gais. Se definió vinculación incorrecta al seguimiento a haber recibido el primer recuento de CD4 > 3 meses después del diagnóstico de VIH. Realizamos un análisis de regresión logística para estimar los factores asociados a una incorrecta vinculación y analizamos las razones subyacentes. RESULTADOS: Un 9,4% refirió incorrecta vinculación al seguimiento. Los diagnosticados en contextos clínicos que no eran clínicas de infecciones de transmisión sexual (ITS) y aquellos diagnosticados en entornos no clínicos presentaron un mayor riesgo de referir una incorrecta vinculación. La razón más frecuente fue que la cita para el primer recuento de CD4 se concedió para > 3 meses después del diagnóstico de VIH. CONCLUSIÓN: La incorrecta vinculación al cuidado es muy baja y para un rendimiento incluso mejor se deberán crear cauces de derivación más rápidos especialmente en contextos más allá de las clínicas de ITS

Correlation of OX40 ligand on B cells with serum total IgE and IL-4 levels by CD4+ T cells in allergic rhinitis

Introduction and objectives: Allergic rhinitis (AR) is a classic Th2-mediated disease, with important contributions to the pathology of interleukins 4, 5, and 13. The co-stimulatory molecule of OX40 and its ligand interaction participate in the immune response by regulation of Th1/Th2 cells balance. Considering the paucity of information on the relation between OX40 ligand (OX40L) and AR, this study aimed to examine its expression on B lymphocytes. Patients and methods: This case-control study consisted of 20 AR patients and 20 healthy subjects. The serum level of total immunoglobulin E (IgE) was measured using the electro-chemiluminescence (ECL) technology. The percentage of B-lymphocytes expressing OX40L was assessed by flow cytometry. The amounts of IL-4 in CD4+ T cells culture supernatant was also measured by the enzyme-linked immunosorbent assay (ELISA). Results: OX40L expression on B lymphocytes of patients was significantly higher than the control group (44.32 ± 19.21% vs. 2.79 ± 2.48% respectively, p < 0.001). In AR patients, OX40L expression correlated positively with the levels of serum total IgE and IL-4 produced by CD4+ T lymphocytes (p < 0.01 - p < 0.05) respectively. Conclusions: Collectively, the findings of this work suggest that there is a relationship between the OX40L expression level on B lymphocytes and allergic markers such as IgE and IL-4 in patients with allergic rhinitis

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Association between environmental exposure and CD4+CD25+ regulatory T cells

Background: It is considered that farm areas protect young patients from allergy and asthma due to high exposure to endotoxins. Aim: To compare CD4+/CD25+ T-regulatory cells and forkhead transcription factor Foxp3 expression in asthmatic children allergic to house dust mites (HDM) living in rural and farm areas. Materials and Methods: This was a prospective analysis of 35 children living in farm areas (n = 19) and rural areas (n = 16), aged 8-16, with allergic rhinitis (allergic to dust mites) and newly diagnosed asthma. Surface molecule CD4+CD25+Foxp3+ expression on cultured PBMCs was estimated by flow cytometry using fluorophore-conjugated monoclonal antibodies in each patient. Results: Thirty-five children were included into the analysis: 19 children living in farm areas and 16 in rural areas. Within and between-groups (farm area vs. rural area) differences in CD4+/CD25+ and CD4+/CD25+Foxp3+ cell expression did not reach the level of significance. Conclusion: The current analysis showed that CD4+/CD25+ and CD4+/CD25+Foxp3+ cell expression was not associated with place of living in asthmatic children sensitive to HDM

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Inmunohistoquímica de las lesiones cutáneas en la lepra y las leprorreacciones / No disponible

Objetivos: 1. Evaluar la immunohistoquimica de los granulomas de la lepra en las muestras de biopsias cutáneas de pacientes con lepra tuberculoide y lepromatosa, con respecto a la presencia y distribución de células T CD4+, CD8+ y CD28+, células CD 68+ y células CD1a+. 2. Evaluar los hallazgos inmunohistoquimicos observados en leprorreacciones. Metodología: Estudio descriptivo. Se seleccionaron para el estudio biopsias cutaneas, en las que se había diagnosticado clínica e histopatologicamente lepra entre el 1.8.2016 al 31.5.2017 en el Instituto Medico Gubernamental, Kozhikode. Se estudió la immunohistoquimica de las lesiones cutáneas en lepra y leprorreacciones, observando específicamente la distribución de células CD4/ CD8/ CD28/ CD68/ CD1a en la lepra en distintos escenarios. Resultados: En el estudio se incluyeron veintiséis casos tuberculoides y 14 lepromatosos. Todos los granulomas independientemente del tipo de enfermedad presentaron tinción positiva por CD4 y CD68. Dos de los 14 casos lepromatosos (14・3%), y 15/26 (57・7%) de las muestras tuberculoides presentaron expresion CD4 de moderada a fuerte. Se detectó negatividad CD28 en cuatro casos tuberculoides (15・4%) y en 10 lepromatosos (71・4%). La expresion CD4 moderada a fuerte se detectó en más del 70% de los T1R incremento mientras que en los demás grupos solo fue de 20%-50%. Más del 80% de las T1R estáticas e incremento presentaban positividad CD28, mayor de que el 30%-50% registrado en otros grupos. Conclusiones: Los resultados revelan que la inmunohistoquimica tiene un papel en aclarar los complejos procesos inmunológicos empleados en la lepra y las leprorreacciones

Objectives: 1. To study the immunohistochemistry of leprosy granulomas in the skin biopsy specimens of patients with tuberculoid and lepromatous leprosy, with respect to the presence and arrangement of CD4+, CD8+ and CD28+ T cells, CD 68+ cells and CD1a+ cells. 2. To study the immunohistochemistry findings observed in leprosy reactions. Design: Descriptive study. Skin biopsies in which the clinical and histopathological diagnosis of leprosy was reported between 1.8.2016 to 31.5.2017 in the Government Medical College, Kozhikode, were selected for the study. Immunohistochemistry of the skin lesions in leprosy and leprosy reactions was studied, looking specifically for the distribution of CD4/ CD8/ CD28/ CD68/ CD1a positive cells in leprosy at different scenarios. Results: Twenty-six tuberculoid and 14 lepromatous cases were included in the study. All granulomas irrespective of disease type showed positive staining for CD4 and CD68. Two of the 14 lepromatous leprosy cases (14・3%), and 15/26 (57・7%) tuberculoid specimens manifested moderate to strong CD4 expression. CD28 negativity was documented in four tuberculoid (15・4%) and 10 lepromatous cases (71・4%). Moderate to strong CD4 expression was noted in more than 70% of upgrading T1R while a similar finding was documented in only 20%-50% of other groups. More than 80% of static and upgrading T1R showed CD28 positivity, which was higher than the 30%-50% positivity recorded in other groups. Conclusions: The observations of the current study indicate a role for immunohistochemistry analysis in delineating the complex immunological processes involved in leprosy and leprosy reactions

Tumoración de rápido crecimiento en la zona anterior del tórax / Rapidly Growing Lesion on the Chest

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Psoriasis asociada al VIH / HIV-Associated Psoriasis

La prevalencia del virus de la inmunodeficiencia humana (VIH) va en aumento en todo el mundo ya que las personas en tratamiento antirretroviral cada vez viven más años. Estos pacientes suelen ser propensos a trastornos inflamatorios debilitantes que suelen ser refractarios al tratamiento estándar. La psoriasis es un trastorno inflamatorio asociado a una carga física y psicológica, y puede ser una característica de presentación de infección por VIH. En esta población de pacientes, la psoriasis suele ser más grave, tener presentaciones atípicas e índices más altos de fracaso a los tratamientos que suelen prescribirse. El manejo de la psoriasis asociada al VIH de carácter moderado y grave es todo un reto. Pueden considerarse agentes convencionales y biológicos, pero debe someterse a los pacientes a un meticuloso seguimiento para descartar posibles episodios adversos tales como infecciones oportunistas, así como una monitorización habitual de los recuentos de CD4 y cargas virales de VIH

Human immunodeficiency virus (HIV) prevalence is increasing worldwide as people on antiretroviral therapy are living longer. These patients are often susceptible to debilitating inflammatory disorders that are frequently refractory to standard treatment. Psoriasis is a systemic inflammatory disorder, associated with both physical and psychological burden, and can be the presenting feature of HIV infection. In this population, psoriasis tends to be more severe, to have atypical presentations and higher failure rates with the usual prescribed treatments. Management of moderate and severe HIV-associated psoriasis is challenging. Systemic conventional and biologic agents may be considered, but patients should be carefully followed up for potential adverse events, like opportunist infections, and regular monitoring of CD4 counts and HIV viral loads

Células T helper foliculares en sangre periférica de pacientes con artritis reumatoide / Follicular helper T cells in peripheral blood of patients with rheumatoid arthritis

Introducción. La artritis reumatoidea (AR) es una enfermedad autoinmune y crónica caracterizada por la presencia de autoanticuerpos como factor reumatoide (FR) y anticuerpos antiproteínas citrulinadas. Una población de células T helper foliculares (Tfh), que expresan CD4+CXCR5+, colabora con las células B para la producción de anticuerpos. La expresión diferencial de CXCR3 y CCR6 dentro de las células CD4+CXCR5+ define 3 subpoblaciones mayores: CXCR3+CCR6− (Tfh1), CXCR3-CCR6− (Tfh2) y CXCR3-CCR6+ (Tfh17). El objetivo del estudio fue evaluar si existe asociación entre el porcentaje de estas células y la AR, y la correlación de las mismas con actividad de la enfermedad. Material y métodos. Participaron 24 pacientes con AR, 22 controles saludables (CS) y 16 pacientes con artritis indiferenciada (AI). Los porcentajes de las células CD4+CXCR5+ y sus subpoblaciones fueron analizados por citometría de flujo. Resultados. No hubo diferencias en los porcentajes de células CD4+CXCR5+ entre los pacientes con AR y CS o entre AR y AI. Tampoco en las subpoblaciones Tfh1, Tfh2 y Tfh17. No hubo correlación entre las células T CD4+CXCR5+, Tfh1, Tfh2 y Tfh17 y el «Disease Activity Score in twenty-eigth joints» (DAS28), así como tampoco con la velocidad de sedimentación globular. Sorpresivamente, hubo una correlación positiva entre las células Tfh17 y la proteína C reactiva. Finalmente, no hubo correlación entre las células TCD4+CXCR5+ o cualquiera de las subpoblaciones y antivimentina mutada citrulinada así como tampoco entre dichas células y el FR. Conclusión. No se hallaron diferencias entre los porcentajes de las células T CD4+CXCR5+ y sus subpoblaciones en sangre periférica de los pacientes con AR y las células de los grupos controles. Esto no descarta un papel patogénico de estas células en el desarrollo y actividad de la AR (AU)

Introduction. Rheumatoid arthritis (RA) is a chronic autoimmune disease that is characterized by the presence of different autoantibodies such as rheumatoid factor (RF) and anti-citrullinated protein antibodies. CD4T cells expressing CXCR5, referred as follicular helper T cells (Tfh), collaborate with B cells to produce antibodies. Differential expression of CXCR3 and CCR6 within CD4+CXCR5+ T cells defines three mayor subsets: CXCR3+CCR6− (Tfh1), CXCR3-CCR6− (Tfh2) and CXCR3-CCR6+ (Tfh17). The aim of the study was to assess whether there is an association between the percentage of these cells and RA and whether there is a correlation with disease activity. Material and methods. Twenty-four RA patients, 22 healthy controls (HC) and 16 undifferentiated arthritis (UA) patients were included. Percentage of CD4+CXCR5+ T cells and their subsets were analyzed by flow cytometry. Results. No differences were found in the percentages of CD4+CXCR5+ T cells in the comparison of RA vs HC or RA vs UA patients. Tfh1, Tfh2 and Tfh17 subsets showed no differences either. There was no correlation between CD4+CXCR5+T cells, Tfh1, Tfh2 and Tfh17, and Disease Activity Score in twenty-eight joints (DAS28) or erythrocyte sedimentation rate. Surprisingly, there was a positive correlation between Tfh17 cells and C-reactive protein. Finally, there was no correlation between CD4+CXCR5+ T cells, or their subsets, and anti-mutated citrullinated vimentin, or between the cells and RF. Conclusion. There were no differences between the percentages of CD4+CXCR5+ T cells and their subsets in peripheral blood of RA patients and the percentages of cells in the control groups. This finding does not rule out a pathogenic role of these cells in the development and activity of RA (AU)

¿Cuál es su diagnóstico? / What is your diagnosis?

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Sarcoma de Kaposi de diagnóstico intraoral / Kaposi's sarcoma intraoral diagnosis

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Role of TIM-3 in ovarian cancer

Evidences have suggested that immunotherapy for ovarian cancer is effective. Immune checkpoints have emerged in the field of cancer immunotherapy. Multiple studies have shown negative regulation of TIM-3 expression on CD4+ and CD8+ T cells and other immunocytes. Overexpression of TIM-3 in innate immune cells has been found in certain types of tumor. The blockade of TIM-3 leads to sustained anti-tumor reactions. TIM-3 plays an inhibitive role for immunity in ovarian cancer. TIM-3 is involved in the development of various subtypes of ovarian cancer and thus has the potential to be a therapeutic target for treatment of ovarian cancer (AU)

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Effect of phototherapy on B and T lymphocytes in Egyptian infants suffering from neonatal jaundice

BACKGROUND: Neonatal jaundice is one of the most common problems that affect newborn infants, and phototherapy is usually used for treatment. OBJECTIVES: Evaluation of the effect of phototherapy on neonatal immune system through measuring the percentage of B and T lymphocytes and determining the frequency of development of infections and need for hospitalisation during the first six months of life. METHODS: A prospective cohort study was conducted on 50 full term new-borns; 25 with indirect hyperbilirubinaemia and treated with conventional phototherapy and 25 healthy matched neonates as untreated controls. The percentages of CD19+, CD4+ and CD8+ lymphocytes were measured by flow cytometry before phototherapy and 72h after exposure. Follow-up of the study group for the occurrence of infections for a period of six months after phototherapy. RESULTS: The study showed a significant difference in CD19+ lymphocytes percentage between patients before phototherapy and controls (P value<0.01), also a significant correlation between serum levels of total bilirubin in patients and CD19+ lymphocytes percentage (P value<0.05). There was no significant difference between the percentages of CD19+, CD4+ and CD8+ lymphocytes in patients before or after 72h of exposure to phototherapy (P value>0.05). Also, there was no correlation between the percentages of CD19+, CD4+ and CD8+ lymphocytes after 72h of exposure to phototherapy and the occurrence of infections (Gastrointestinal tract and Respiratory tract infection) after six months of follow-up (P value>0.05). More studies are needed with larger number of patients to determine the effect of phototherapy on immune system

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Fenotipos del asma, ¿son importantes? / Asthma Phenotypes; Do They Matter?

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Homeopathic mistletoe adverse reaction mimics nodal involvement in 18F-FDG PET/CT performed for evaluation of response to chemotherapy in lymphoma / Reacción adversa a muérdago homeopático que imita infiltración ganglionar en 18F-FDG PET/TC realizada para valorar la respuesta a quimioterapia en linfoma

Some patients use complementary medicine. We present a patient with Hodgkin's lymphoma, scanned with 18F-FDG PET/CT for evaluation of response after chemotherapy, who was self-administering mistletoe as a homeopathic medicine product. The careful review of the images of the entire scan and patient collaboration in anamnesis were crucial to avoid a false positive result. A review of the published scientific data on the effects of mistletoe is also presented (AU)

Algunas personas usan terapias alternativas. Presentamos el caso de una paciente con enfermedad de Hodgkin a la que se realiza una 18F-FDG PET/TC para evaluar la respuesta tras quimioterapia, en paciente que se autoadministraba muérdago como tratamiento homeopático. La cuidadosa evaluación de todas las imágenes de la prueba y la colaboración de la paciente durante la anamnesis fueron cruciales para evitar un resultado falso positivo. Además, se revisan los datos publicados sobre los efectos del muérdago (AU)

HIV-1 p24 and CD4+ T cell count during boosted protease-inhibitor monotherapy in HIV-infected patients / P24 y recuentos de CD4 durante el tratamiento con inhibidores de la proteasa potenciados en monoterapia

BACKGROUND: Plasma HIV p24 is considered a significant predictor of CD4+ T cell decline and progression to AIDS in HIV-infected patients. We evaluated the p24 levels in patients on triple therapy and after switching to ritonavir-boosted protease inhibitor monotherapy (mtPI/rtv), as well as the relationships with virological and immunological evolution. MATERIALS AND METHODS: Plasma samples from patients participating in two studies of simplification to mtPI/rtv were analysed for presence of p24, using a boosted enzyme-linked immunosorbent assay specific for mature p24. Only patients with available samples at baseline (on triple therapy) and during a follow-up of at least 12 months after switching to mtPI/rtv were included. RESULTS: A total of 233 samples from 51 patients were analysed. After switching to mtPI/rtv and a median follow-up of 24 months, 14 patients maintained continuous undetectable viraemia, and 37 patients experienced a total of 49 transient viraemic episodes. Unexpectedly, the evolutionary p24 patterns were uniform for most patients, both before and after switching to mtPI/rtv, independently of the virological behaviour, fitting into one of three categories: persistent undetectable p24 levels, positive p24, matching only with the viraemic episodes, and persistent detectable p24 levels. The last group showed lower CD4+ T cell counts and percentages, as well as lower CD4+/CD8+ T cell ratios after 12 and 24 months of follow up. CONCLUSION: Treatment simplification to mtPI/rtv does not influence the behaviour of p24 in plasma. Patients with continuous positive p24, despite undetectable viraemia, showed worse immunological evolution

INTRODUCCIÓN: El antígeno p24 se considera un buen predictor de caída de los recuentos de linfocitos T CD4+ y de progresión a sida en pacientes infectados por el VIH. En este estudio hemos evaluado la presencia de p24 en plasma y su relación con la evolución virológica e inmunológica durante la monoterapia con inhibidores de la proteasa potenciados (mtPI/rtv). MATERIAL Y MÉTODOS: Se analizaron muestras de pacientes que participaron en 2 estudios de simplificación con mtPI/rtv. Las concentraciones de p24 se midieron mediante un ELISA potenciado específico para p24 madura. Solo se incluyeron los pacientes con muestras disponibles basalmente (en triple terapia) y durante≥12 meses de seguimiento con mtPI/rtv. RESULTADOS: Se analizaron un total de 233 muestras de 51 pacientes. Tras la simplificación y una mediana de seguimiento de 24 meses, 14 pacientes mantuvieron una viremia indetectable de forma continuada, mientras que se observaron 49 episodios de viremia transitoria en los 37 restantes. Las determinaciones de p24 fueron estables en la mayoría de los pacientes, tanto antes como después del cambio a mtIP/rtv, independientemente del comportamiento virológico, incluyéndose en una de las siguientes categorías: p24 indetectable persistentemente, p24 positiva coincidiendo solo con los episodios de viremia transitoria, y p24 detectable en todas las determinaciones. Este último grupo mostró recuentos y porcentajes de linfocitos T CD4+ más bajos, así como cocientes CD4+/CD8+ inferiores tras 12 y 24 meses de seguimiento. CONCLUSIÓN: La simplificación a mtPI/r no modifica el comportamiento de la p24 en plasma. Los pacientes con detección persistente de p24 en plasma a pesar de una viremia indetectable muestran una peor evolución inmunológica